Provider Demographics
NPI:1730885617
Name:KIM, DAVID SANGHYUN
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:SANGHYUN
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3184 OCEAN BEACH HWY
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-4395
Mailing Address - Country:US
Mailing Address - Phone:360-636-6723
Mailing Address - Fax:
Practice Address - Street 1:3184 OCEAN BEACH HWY
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-4395
Practice Address - Country:US
Practice Address - Phone:360-636-6723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH613303381835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist